August 2023 to November 2023
Authors: Aleksandra Opinc-Rosiak and Giacomo Cafaro
The Lancet Rheumatology
Colchicine vs Prednisone for calcium pyrophosphate arthritis
Pascart et al (doi.org/10.1016/S2665-9913(23)00165-0) compared the efficacy and safety of colchicine and prednisone for the treatment of acute calcium pyrophosphate arthritis in an open-label, multicentre, randomised trial. The primary outcome was the reduction in pain on a 0-100 visual analog scale. At 24h colchicine and prednisone were responsible for a pain reduction of 36 (SD=32) and 38 (SD=23), respectively, thus demonstrating equivalence. However, diarrhoea was more common in the colchicine group, while hypertension and hyperglycemia in the prednisone group.
Multiple biosimilar switching
Fleischmann et al (doi.org/ 10.1016/S2665-9913(23)00161-3) evaluated the effect of multiple switching between reference adalimumab and biosimilar adalimumab-afzb in terms of safety and pharmacokinetics in a open-label, randomised trial. Patients were allocated to reference adalimumab or to a triple switch between the two brands. Among the 427 patients that completed the first 10 weeks of the study, no significant differences were found in terms of pharmacokinetic parameters (area under plasma concentration–time curve= 2237 and 2125 µg x h/ml) in the switching and non-switching group, respectively. No significant differences were found in terms of severe adverse events.
Risk of lupus flare following treatment tapering according to disease activity status
Cho et al (doi.org/10.1016/S2665-9913(23)00209-6) investigated the risk of lupus flare in a very large cohort of patients (3002) undergoing treatment tapering (steroids or immunosuppressants) by stratifying disease activity at the moment of tapering in LLDAS, DORIS remission or complete remission (DORIS remission + SLEDAI-2k=0 ). The rate of flares in 1 year following tapering was significantly higher in LLDAS and DORIS remission than complete remission (OR: 1.37 [95%CI: 1.03 to 1.81] and 1.45 [95%CI: 1.08 to 1.94], respectively). Overall, tapering showed a higher rate of flares compared to unchanged treatment (OR: 1.24 [95%CI: 1.10-1.39]).
Clinical trial of synovial pathology-guided treatment in RA
Rivellese et al (doi.org/10.1016/S2665-9913(23)00241-2) reported the results of two randomised trials in which biological-naïve RA patients were randomised to treatment with etanercept, tocilizumab or rituximab based on the results of a synovial biopsy, which was simply classified into B cell rich and B cell poor. No significant differences in terms of response rate were found in etanercept and tocilizumab (pooled together) vs rituximab, neither in the B cell rich, nor in the B cell poor groups. These data entail that a detailed characterization of synovial tissue is likely required to inform treatment.
Tocilizumab allows very short treatment with glucocorticoids in giant cell arteritis
Unizony et al (doi:org/10.1016/S2665-9913(23)00265-5) evaluated the efficacy of a very short glucocorticoid treatment + tocilizumab in patients with giant-cell arteritis in an open-label single arm pilot study. They found that 8 weeks of glucocorticoids allowed to achieve a steroid-free remission rate at 52 weeks of 77% with an overall good safety profile. These results provide a solid background for a randomised controlled trial.
Aleksandra Opinc-Rosiak
Aleksandra is a research and teaching assistantat the Medical University of Lodz, Poland, and a trainee in rheumatology at the USK-WAM Hospital in Lodz. Her main research interests are idiopathic inflammatory myopathies and autoantibodies. Aleksandra is a member of the Newsletter sub-committee.
Giacomo Cafaro
Giacomo is an Assistant Professor of Rheumatology and Consultant Rheumatologist at University of Perugia, Italy. His main research interests are T cell biology in autoimmune diseases, psoriatic arthritis, Sjögren’s syndrome and ultrasound in rheumatology. Giacomo is a member of the Newsletter sub-committee.